Hypothalamic deep brain stimulation for cluster headache: experience from a new multicase series

被引：102

作者：

Bartsch, T. ^{[1
]}

Pinsker, M. O. ^{[2
]}

Rasche, D. ^{[3
]}

Kinfe, T. ^{[6
]}

Hertel, F. ^{[4
]}

Diener, H. C. ^{[5
]}

Tronnier, V. ^{[3
]}

Mehdorn, H. M. ^{[2
]}

Volkmann, J. ^{[1
]}

Deuschl, G. ^{[1
]}

Krauss, J. K. ^{[6
]}

机构：

[1] Univ Hosp Schleswig Holstein, Dept Neurol, D-24105 Kiel, Germany

[2] Univ Hosp Schleswig Holstein, Dept Neurosurg, D-24105 Kiel, Germany

[3] Univ Hosp Schleswig Holstein, Dept Neurosurg, Lubeck, Germany

[4] SHG Klin, Dept Neurosurg, Idar Oberstein, Germany

[5] Univ Essen Gesamthsch, Dept Neurol, D-4300 Essen, Germany

[6] Hannover Med Sch, Dept Neurosurg, D-3000 Hannover, Germany

来源：

CEPHALALGIA | 2008年 / 28卷 / 03期

关键词：

cluster headache; hypothalamus; deep brain stimulation; pain modulation;

D O I：

10.1111/j.1468-2982.2007.01531.x

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Deep brain stimulation (DBS) of the posterior hypothalamus was found to be effective in the treatment of drug-resistant chronic cluster headache. We report the results of a multicentre case series of six patients with chronic cluster headache in whom a DBS in the posterior hypothalamus was performed. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to published coordinates 2 mm lateral, 3 mm posterior and 5 mm inferior referenced to the mid-AC-PC line. Microelectrode recordings at the target revealed single unit activity with a mean discharge rate of 17 Hz (range 13-35 Hz, n = 4). Out of six patients, four showed a profound decrease of their attack frequency and pain intensity on the visual analogue scale during the first 6 months. Of these, one patient was attack free for 6 months under neurostimulation before returning to the baseline which led to abortion of the DBS. Two patients had experienced only a marginal, non-significant decrease within the first weeks under neurostimulation before returning to their former attack frequency. After a mean follow-up of 17 months, three patients are almost completely attack free, whereas three patients can be considered as treatment failures. The stimulation was well tolerated and stimulation-related side-effects were not observed on long term. DBS of the posterior inferior hypothalamus is an effective therapeutic option in a subset of patients. Future controlled multicentre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders.

引用

页码：285 / 295

页数：11